From the School of Sociology and Anthropology, Sun Yat-Sen University (Fang), Guangzhou, Guangdong; Department of Sociology, Central South University (Liu), Changsha, Hunan, People's Republic of China; Department of Social Work, Hong Kong Baptist University (Yang), Kowloon Tong, Hong Kong; and Department of General Surgery, The Second Affiliated Hospital, Shantou University Medical College (Xu, Chen), Shantou, Guangdong, People's Republic of China.
Psychosom Med. 2020 Feb/Mar;82(2):197-207. doi: 10.1097/PSY.0000000000000772.
This study aimed to examine the association between social isolation, change in severity of depression, and subsequent recurrence of peptic ulcer disease (PUD) in older adults with mild cognitive impairment.
Older adults (≥55 years) with mild cognitive impairment and Helicobacter pylori-infected PUD (N = 2208) were recruited between 2010 and 2014 from 12 hospitals in the People's Republic of China. H. pylori was eradicated and PUD was cleared in 2015 participants by the end of 2014; 1900 of these were followed up for up to 36 months. The Kaplan-Meier method was used to assess how PUD recurrence varied with social engagement levels and changes in depression severity. Multivariate Cox proportional hazard models were used to examine associations between social isolation, changes in depression severity, and PUD recurrence.
PUD recurrence was more prevalent in socially isolated (10.8%) than in socially engaged participants (5.5%). However, the rates of PUD were lower in socially isolated individuals without (absence of) depression (7.2%) and those with decreased depression (8.2%), whereas socially isolated individuals with unchanged and increased depression had substantially higher rates of PUD (16.3% and 17.8%, respectively; the social isolation by depression group for PUD recurrence was significant (p < .001). Specifically, although social isolation was associated with PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 2.665 [1.602-4.518]), it did not increase PUD recurrence risk in participants without depression or with reduced depression. However, in participants with unchanged or increased depression, PUD recurrence was more likely to occur in socially isolated (HR = 1.587 [1.125-2.588]; HR = 1.886 [1.012, 3.522] respectively) than in socially engaged participants.
Social isolation is associated with a greater risk of PUD recurrence; however, the absence of or decreased severity of depression may alter this relationship.
本研究旨在探讨老年人社会隔离、抑郁严重程度变化与随后消化性溃疡病（PUD）复发之间的关系。
本研究纳入了 2010 年至 2014 年间中国 12 家医院的 2208 名年龄≥55 岁、有轻度认知障碍且合并幽门螺杆菌感染的 PUD 患者。2014 年底，所有患者接受了幽门螺杆菌根除治疗，PUD 也得到了清除；其中 1900 名患者接受了长达 36 个月的随访。Kaplan-Meier 法用于评估 PUD 复发与社会参与水平和抑郁严重程度变化之间的关系。多变量 Cox 比例风险模型用于研究社会隔离、抑郁严重程度变化与 PUD 复发之间的关系。
社会隔离组（10.8%）较社会参与组（5.5%）PUD 复发更为常见。然而，在无抑郁（7.2%）和抑郁减轻（8.2%）的社会隔离患者中，PUD 发生率较低，而在抑郁无变化和抑郁加重的社会隔离患者中，PUD 发生率较高（分别为 16.3%和 17.8%；抑郁分组的社会隔离对 PUD 复发有显著影响（p<.001）。具体而言，尽管社会隔离与 36 个月随访期间的 PUD 复发相关（风险比[HR] = 2.665[1.602-4.518]），但在无抑郁或抑郁减轻的患者中，社会隔离并未增加 PUD 复发风险。然而，在抑郁无变化或加重的患者中，社会隔离更易导致 PUD 复发（HR = 1.587[1.125-2.588]；HR = 1.886[1.012, 3.522]）。
社会隔离与 PUD 复发风险增加相关；然而，抑郁的缺失或减轻可能会改变这种关系。
